• Dr. Donald Littlewood

What you need to know about forward head posture

We’re back in March 2020 and the big boss man of your company sent you an email that you’re going to be working from home for the next little bit because of COVID19. If you are in Toronto, the mayor has strongly suggested that you continue to work from home until September. Some companies have told their employees that they won’t go back until 2021.


By this point, chances are you have figured out what your desk should and should not look like. I would also imagine that you have had a conversation or two with your work about what kind of laptop riser, external monitor and standing desk you may or may not need.


But that is not going to completely resolve the pain you’re experiencing in your neck & upper back.


It also isn’t going to train your body to maintain proper posture.


That’s where I come in.



The basics of forward head posture

Before we chat about how to correct forward head posture, we need to talk about what it is in the first place.


Posture is actually a more complicated topic than people think. It involves your head, neck, shoulders, mid back, low back, core & pelvis. Now obviously I cannot talk about all of those things in this blog, that would be exhausting (and so long you wouldn’t read it), so I am going to concentrate on the head, neck & upper back.


What is forward head posture?


FHP is defined as: hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae.1 What does that actually mean? It means that the bottom portion of the neck is bent too far forward and the joints of the upper neck have to extend back to compensate for what is going on.


This can lead to a whole host of problems: neck pain, upper/midback pain, headaches, jaw issues, weakened respiratory function, etc. The list goes on.


How can you tell if you have FHP?


Well chances are you are reading this because you already know that your FHP is an issue, BUT if you’re wondering, I wanted to give you a quick way to check. And all it involves is your cell phone.


Prop your cell phone up on a shelf, set your self timer and take a side profile selfie (you only need to see from the chest up for right now). When you look at the image, take a look at where your head lies in relationship to your shoulder. Ideally your ear lobe, shoulder, elbow, hip and ankle should be in a straight line. My guess is that you will notice your earlobes being a few inches in front of your shoulders.


Implications of forward head posture

So you have now decided that you might have FHP; my guess is that you are now wondering about the implications of FHP.


Well the first one is probably one you are feeling fairly often & my guess is the reason you are here: neck pain.


Neck pain can be caused by a number of different ways but one of the most common ways is through the musculature. Muscles can either be short or long & both have their implications when it comes to pain & dysfunction.


Short muscles don’t allow the body part to go through its entire range of motion efficiently. On the other hand, long muscles are often weak and therefore range of motion is limited because the muscle isn’t strong enough to move the joints.


Obviously neither of these situations is ideal. Both short & long muscles can lead to a large amount of pain that we just don’t need.


When we talk about pain caused by forward head posture, we cannot leave headaches out of the conversation.


Neck pain and headaches are very intimately related. There is an entire type of headache called a cervicogenic headache that is caused directly from the structures of the neck. These headaches are really common in those with forward head posture.


Why? Well FHP causes extra stress on the upper cervical structures, so the muscles, joints & ligaments from the skull to the third cervical vertebrae. This means that the suboccipital muscles, the deep neck flexors, the upper trapezius muscles (among others) are all at play.


We know that poor self esteem can cause FHP, but there is some new research out there saying that there might be a link in the reverse as well - that FHP can cause low self esteem.


We’ve talked about how FPH can contribute (or cause) neck pain & headaches, so now I think it is time to chat about the real reason you are here.


How to improve your forward head posture

Before I start on this, I want to be very frank on two things:

  • Improving your posture is not a quick fix; it takes time & effort

  • I don’t believe in “perfect posture”. Why? Because no one is perfect and putting that expectation on yourself is setting yourself up for failure. I do believe in better posture, and my goal is to show you that.


Now with that out of the way: let’s get to the good stuff.


Get your workstation together

If you’ve been around these parts for a while you’ll know that I am big on a proper workstation. If you’ve been working throughout COVID19, I’m sure you’ll have realized that working from your laptop on the couch just simply isn’t going to cut it.


But since I’ve been back at work, I would say 80% of my patients have questions about what their workstation should look like. So here I am dishing all that out for you today.


The first thing you should look at is the height of your monitor. In an ideal world, you want the top line of text to be at eye level. This is going to prevent you from looking down which will help you decrease the amount of FHP you have while working.


The second thing you should do is get an external mouse & keyboard. To me, this is a no-brainer. If you are working from a laptop and you’ve raised it up then you will soon find that typing and navigating is difficult. An external mouse & keyboard is going to change that for you.


Pro tip: when you are working, try and keep your mouse & keyboard as close to your body as you can. The more extension in your arm (i.e., reaching for your mouse & keyboard) the more pain you will have in your upper back & neck. This is something I am seeing a lot of in practice.


The one exercise you should be doing

Now, I don’t usually say “there is one exercise you should be doing for _______”, because it isn’t generally a one size fits all approach, but this is the one exercise you should be doing for forward head posture.



Chin tucks

If you’ve been here for a while, you will know that this is a favourite, go-to of mine that I use myself & recommend to patients.


But why fix something that isn’t broken?!


To do this exercise, you are going to sit comfortably in a chair. Then you are going to literally give yourself a double chin. Repeat it 10-12 times, twice a day.


That’s it. Couldn’t get easier, right?!


I wanted to also include a free resource for you on a few more exercises you can do to improve that pesky FHP. These are exercises I use myself everyday and ones that I give to my patients on the regular. Now obviously this resource is not an exhaustive list, but it is an excellent place to start. Head on over to www.drdonaldlittlewood.com/posture-exercises to get your copy today!

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